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General NPI Number Information
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NPI Number | 1740551712
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Entity Type | Individual
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Provider Name | ADAM SMITH FNP-C
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Gender | Male
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Dates
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Enumeration Date | 01/23/2012
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Last Update Date | 10/28/2019
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Provider Practice Location Address
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Address Line | 3416 GULF BREEZE PKWY
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City | GULF BREEZE
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State | FL
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Zip | 32563
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Country | US
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Telephone | 850-934-5713
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Fax |
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Provider Business Mailing Address
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Address Line | 6229 PINE BLOSSOM RD
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City | MILTON
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State | FL
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Zip | 32570-7867
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Country | US
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Telephone | 601-549-8444
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 9430363
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License Number State | FL
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